In cool scientific news, MIT scientists are investigating a drug with the potential to attack virtually any virus. Such a broad spectrum antiviral, should it pan out, would be an amazing development.
n a development that could transform how viral infections are treated, a team of researchers at MIT’s Lincoln Laboratory has designed a drug that can identify cells that have been infected by any type of virus, then kill those cells to terminate the infection.
In a paper published July 27 in the journal PLoS One, the researchers tested their drug against 15 viruses, and found it was effective against all of them — including rhinoviruses that cause the common cold, H1N1 influenza, a stomach virus, a polio virus, dengue fever and several other types of hemorrhagic fever.
The drug works by targeting a type of RNA produced only in cells that have been infected by viruses. “In theory, it should work against all viruses,” says Todd Rider, a senior staff scientist in Lincoln Laboratory’s Chemical, Biological, and Nanoscale Technologies Group who invented the new technology.
Because the technology is so broad-spectrum, it could potentially also be used to combat outbreaks of new viruses, such as the 2003 SARS (severe acute respiratory syndrome) outbreak, Rider says.
Of course, it will be a long while till we know if this really works.
August 15th, 2011
Tabatha Southey, in the Globe and Mail, comments on the stupidity of swine flu conspiracy theories percolating around these days. The one thing I disagree with is that the problem isn’t skepticism, but certainty. If only those contemplating swine flu, or 911, or vaccine and autism, conspiracy theories would be as skeptical about their alternative theories as they are about the conventional view. But they exhibit the certainty that does not allow any alternative possibilities to be considered.
Conspiracy theories are great, because anyone who raises weaknesses in them is either gullible or in on the conspiracy. The points raised by these individuals can, thus, be ignored.
The problem, however, for all of us, is that we cannot dismiss conspiracy theories out of hand because conspiracies do, in fact exist. The CIA really did have a mind control program called MKULTRA that they kept secret for decades. The Bush-Blair administrations really did lie about Iraq. And the US has overthrown many governments around the world, often accompanied by vigorous denials.
The only thing we can do is remain respectful, and skeptical, of evidence. In particular, as I always tell my students, and try to practice myself, one should be especially skeptical of evidence which supports one’s pet theories and respectful of that which challenges them.
But, in any case, we live in a world of partial knowledge and of error and of uncertainty. Take the Kennedy assassination. There may, or may not, have been some type of conspiracy. Or there may just have been a covering up of incompetence. Many of us may never be certain what happened. That may be the best we can do. It’s certainly better than being certain of that which we can never reasonably be certain. That’s the nature of reason, and of life.
The Southey article:
On swine-flu conspiracy theories
Theories spring from a society so skeptical that it’s actually gullible
I wish I could sustain enough faith in humanity to believe in the conspiracy theories that I’ve heard recently regarding the H1N1 vaccine.
If government and pharmaceutical companies are capable of working together, with medical professionals, all committed to doing pure evil, this would at least demonstrate that mankind is capable of completing mammoth, future-altering projects.
We’re just choosing not to.
I’d sleep better knowing that there was a race of Bond villains among us. The task of converting all of that collective inventiveness and industriousness from diabolical evil into good would be simple, compared with the work of organizing actual messy people and mismanaged institutions into anything capable of achieving something momentous. At least the infrastructure would be there.
If H1N1 is a pharmaceutical-company scam, as I’ve been repeatedly told, or if 9/11 was an inside job, or if all of the peer-reviewed articles proving the existence of climate change were manufactured for eventual political gain, at least the human race would have demonstrated great foresight and ambition.
After all, it would arguably have been more difficult and imaginative to fake a moon landing than it was to actually land on the plain, old moon.
And, most impressively, in an era in which apparently many people can’t make a casserole without “tweeting” that fact, these evil endeavours would’ve required discretion: No one ever talks.
It’d be reassuring to think 9/11 was an inside job. But if the people who pulled that off were, as the theory runs, the same people who subsequently invaded Iraq, Baghdad would be running like Geneva right now. At least those towers stayed down.
Oh, I know, they want it to be a mess so they can stay in Iraq; that’s Part 2 of the theory. Again, it’d be nice to think that “they” ever felt that they needed an excuse.
It’s as if humanity had come a full 360 degrees. We’ve moved from the credulousness that thrives on ignorance (excusable when we were actually ignorant), to a healthy skepticism, to just skepticism, to cynicism. And this led increasing numbers of people right back to credulousness again.
The impulse to question (sit in on any undergraduate class if you don’t believe me) is currently perhaps validated above the impulse to learn, or at least to learn first. And into that educational void, far more entertaining and easily communicated conspiracy theories have flooded.
The anti-vaccination movement, whose conspiracy-like claims shift as they’re repeatedly debunked, thrives on a kind of reborn superstition, mainly by connecting vaccination to autism. It’s a perfect example of pseudo-religious irrationality in that it offers conscientious parents a simple way to protect their children against something complex and frightening – autism.
Which would be great, if it were remotely true, because it would mean that bad things don’t happen to good people. Which would be really great.
Ask people who have had cancer and they’ll tell you that the initial sympathetic response of their associates quickly becomes a kind of 20-questions game designed to determine how the newly diagnosed people brought this cancer upon themselves.
As the mother of a child who was for a long time highly “special needs,” I was sometimes tempted to tell horrified new or pregnant mothers who witnessed the grimmer moments of our lives that “I drank heavily only in the first trimester,” just to put their minds at ease. They would never be us. Too good. Too clever.
People keep announcing that they’re “buying vitamins” in response to H1N1, which ignores the dual realities that immunizations work best when as many people as possible are immunized (in an orderly fashion and beginning always with the Calgary Flames) and that healthy people do become ill.
Historically, people routinely watched healthy people get sick and die at home – as we seldom do. Having few other options, they fought back mostly with a kind of magical thinking, believing in an imbalance of humours and in “the cursed.”
Here again, having gone past dull science – which has, after all, failed to save every last one of us from everything – we’re now coming around 360 degrees to attempting to ward off illness, simplified as evil, with insider information.
“I’m boosting my immune system,” people keep saying to me, beatifically.
The phrase is like a new “Hail, Mary, mother of God” – it’s said as if the mere knowledge of the words, and the things the utterance of those words suggests about the speaker, provided special protection.
[H/t, yet again, Effect Measure.]
November 15th, 2009
Barbara Ehrenreich elaborates on the point of her recent book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America by examining the dangers of overly optimistic thinking, and trust in private companies, when it comes to protecting our public health:
The Swine Flu Vaccine Screw-up
Optimism as a Public Health Problem
by Barbara Ehrenreich
If you can’t find any swine flu vaccine for your kids, it won’t be for a lack of positive thinking. In fact, the whole flu snafu is being blamed on “undue optimism” on the part of both the Obama administration and Big Pharma.
Optimism is supposed to be good for our health. According to the academic “positive psychologists,” as well as legions of unlicensed life coaches and inspirational speakers, optimism wards off common illnesses, contributes to recovery from cancer, and extends longevity. To its promoters, optimism is practically a miracle vaccine, so essential that we need to start inoculating Americans with it in the public schools — in the form of “optimism training.”
But optimism turns out to be less than salubrious when it comes to public health. In July, the federal government promised to have 160 million doses of H1N1 vaccine ready for distribution by the end of October. Instead, only 28 million doses are now ready to go, and optimism is the obvious culprit. “Road to Flu Vaccine Shortfall, Paved With Undue Optimism,” was the headline of a front page article in the October 26th New York Times. In the conventional spin, the vaccine shortage is now “threatening to undermine public confidence in government.” If the federal government couldn’t get this right, the pundits are already asking, how can we trust it with health reform?
But let’s stop a minute and also ask: Who really screwed up here — the government or private pharmaceutical companies, including GlaxoSmithKline, Novartis, and three others that had agreed to manufacture and deliver the vaccine by late fall? Last spring and summer, those companies gleefully gobbled up $2 billion worth of government contracts for vaccine production, promising to have every American, or at least every American child and pregnant woman, supplied with vaccine before trick-or-treating season began.
According to Health and Human Services Secretary Kathleen Sebelius, the government was misled by these companies, which failed to report manufacturing delays as they arose. Her department, she says, was “relying on the manufacturers to give us their numbers, and as soon as we got numbers we put them out to the public. It does appear now that those numbers were overly rosy.”
If, in fact, there’s a political parable here, it’s about Big Government’s sweetly trusting reliance on Big Business to safeguard the public health: Let the private insurance companies manage health financing; let profit-making hospital chains deliver health care; let Big Pharma provide safe and affordable medications. As it happens, though, all these entities have a priority that regularly overrides the public’s health, and that is, of course, profit — which has led insurance companies to function as “death panels,” excluding those who might ever need care, and for-profit hospitals to turn away the indigent, the pregnant, and the uninsured.
As for Big Pharma, the truth is that they’re just not all that into vaccines, traditionally preferring to manufacture drugs for such plagues as erectile dysfunction, social anxiety, and restless leg syndrome. Vaccines can be tricky and less than maximally profitable to manufacture. They go out of style with every microbial mutation, and usually it’s the government, rather than cunning direct-to-consumer commercials, that determines who gets them. So it should have been no surprise that Big Pharma approached the H1N1 problem ploddingly, using a 50-year old technology involving the production of the virus in chicken eggs, a method long since abandoned by China and the European Union.Chicken eggs are fine for omelets, but they have quickly proved to be a poor growth medium for the viral “seed” strain used to make H1N1 vaccine. There are alternative “cell culture” methods that could produce the vaccine much faster, but in complete defiance of the conventional wisdom that private enterprise is always more innovative and resourceful than government, Big Pharma did not demand that they be made available for this year’s swine flu epidemic. Just for the record, those alternative methods have been developed with government funding, which is also the source of almost all our basic knowledge of viruses.
So, thanks to the drug companies, optimism has been about as effective in warding off H1N1 as amulets or fairy dust. Both the government and Big Pharma were indeed overly optimistic about the latter’s ability to supply the vaccine, leaving those of us who are involved in the care of small children with little to rely on but hope — hope that the epidemic will fade out on its own, hope that our loved ones have the luck to survive it.
And contrary to the claims of the positive psychologists, optimism itself is neither an elixir, nor a life-saving vaccine. Recent studies show that optimism — or positive feelings — do not affect recovery from a variety of cancers, including those of the breast, lungs, neck, and throat. Furthermore, the evidence that optimism prolongs life has turned out to be shaky at best: one study of nuns frequently cited as proof positive of optimism’s healthful effects turned out, in fact, only to show that nuns who wrote more eloquently about their vows in their early twenties tended to outlive those whose written statements were clunkier.
Are we ready to abandon faith-based medicine of both the individual and public health variety? Faith in private enterprise and the market has now left us open to a swine flu epidemic; faith alone — in the form of optimism or hope — does not kill viruses or cancer cells. On the public health front, we need to socialize vaccine manufacture as well as its distribution. Then, if the supply falls short, we can always impeach the president. On the individual front, there’s always soap and water.
© 2009 TomDispatch.com
November 4th, 2009
Public health is bedeviled by the public’s lack of understanding of uncertainty. Public health policy deals with potential future events. Decisions about policy have to be made with often inadequate data. If, as often happens, bad scenarios don’t unfold, policy-makers may well have made make decisions that turn out to be wrong in the sense that the preventive efforts were taken that turned out not to be needed.
We see this in the case of the current H1N1 swine flu pandemic. Skeptics are using the initial concerns about worst case scenarios, which turned out to be wrong when more data was available, to encourage skepticism about current plans to cope with a looming pandemic. We see this reasoning in a recent Alternet article by Joshua Holland – H1N1 Just Isn’t That Scary: Why There’s No Reason to Go Overboard with Swine Flu Hysteria — which claims that swine flu fears are more dangerous than the swine flu itself. [Holland's article received a furious rebuttal -- More crappy flu journalism, this time Alternet [rant alert!] — from revere at Effect Measure with which I strongly concur. My comments complement revere’s.]
Holland refers to comments last spring abut the potential danger:
In April, Homeland Security Chief Janet Napolitano called a press conference and declared a public-health emergency. In August, officials for the Centers for Disease Control warned that H1N1 could infect half of the U.S. population and kill 90,000 Americans by year’s end. CDC officials estimated that 1 in 10 New Yorkers had contracted the virus this spring.
Holland refers to these estimates as “grist for their [the media's] sensationalist mills.” He, however, makes no argument that the data available in spring 2009 were not consistent with these warnings. We had a highly contagious, fast-spreading pandemic flu strain to which no one under 52 had any apparent immunity. Those most affected by the pandemic were the young. We had reports of many deaths in Mexico, and we had the awareness that influenza has the ability to rapidly mutate. There were a number of deaths of young patients, which is atypical for the seasonal flu.
To not take action, issue warnings, consider school closings, and start a vaccine development program would have been highly negligent. Had the pandemic developed differently, as could well have occurred, likely, many of the same people now criticizing the “hysteria” would soon be screaming at the incompetence or corruption of a public health policy establishment that failed to respond to a looming crisis.
In any case, Holland and similar writers fail to understand that, even with the relatively low severity of the swine flu at this point, the overall risk is greater because of the lack of immunity in the population. Thus, a much larger percentage of the population is likely be become infected. If even a small proportion of the infected become very ill and require hospitalization, our emergency medical system, already operating under great continuous strain, will face much greater strain. Large numbers of severely ill people may be turned away from ERs, to take their chances at home. revere explains the problem:
Our big city emergency rooms periodically and routinely go “on diversion,” meaning that they divert the ambulance that’s on its way their hospital to another hospital. The main reason is not the already ludicrous long waits in the ER but the shortage of critical care beds, the ones with the ventilators and skilled nursing that Holland thinks will now save people seriously ill with flu. It’s a common mistake. But it’s a mistake.
In a healthcare system from which most excess capacity has been wrung by budget cuts, even a mild pandemic can cause severe disruption. If the vaccination program only avoided this eventuality, it would be worth it, contra Holland. But, like the seasonal flu vaccine it is likely to reduce many forms of illness-caused social disruption and save lives. Likely thousands. Possibly many more.
Holland, however, recommends that the non-health professionals among us just ignore swine flu:
The take-away from all this is that the best cure for swine flu hysteria may be a healthy dose of salt….
Public-health officials, epidemiologists and clinicians have to worry about H1N1. As things stand, you really don’t.
In these statements Holland uses the common commentator’s trick to pose the options as “hysteria” or forgetting about it, as if those are the only options. Of course, hysteria is never useful. But cautious alertness often is.
Additionally, public health policy to deal with a situation like the swine flu pandemic requires the allocation of public resources and the development of plans and the carrying out of preparatory measures by many in a multitude of systems throughout society. Both resource allocation and preparedness planning cannot successfully be carried out without public involvement and an informed citizenry.
Holland, however, fails the primary task of both journalists and the public heath community of helping people understand the uncertainties and complexities of the situation, developing preparations for potential bad scenarios, and helping people cope, no matter how events unfold. Accurate knowledge and understanding, including knowledge of uncertainties and limits to our information, are among the most effective public heath tools. Unfortunately, Holland’s article is no help in developing these tools.
September 27th, 2009
revere at Effect Measure has a followup to yesterday’s post I re-posted on swine flu vaccine in which he responds to critics. Well worth a read.Here is the section on why rever believes the vaccine should contain adjuvants to increase immunity:
Jody Lanard and Peter Sandman are among the most experienced and thoughtful practitioners of risk communication anywhere, so their views are of special significance. We usually agree, although not always. This seems to be one of the “not always” times. Jody’s concern has to do with how the US public will react to the idea that a relatively untested vaccine will contain an even more untested additive, especially after the 1976 swine flu debacle where it is widely reported that the vaccine was worse than the disease (although not reported that one reason this is so is that the disease never got out of Fort Dix so there was no disease averted by the vaccine). This comes at a time of high anxiety about vaccines among certain segments of the population, some of it sincere, much of it fed by paranoid conspiracy theorists who see monsters under every bed. The bad behavior of Big Pharma and the demonizing by the Far Right Noise Machine of any health measure promoted by government adds to the problem. The result is that the anti-vaxxer movement is killing and disabling children. The fear is that a government program with an adjuvanted vaccine will pour gasoline on this fire:
There is a great deal of undue — but thoroughly unmitigated — anti-vaccine feeling and fear in the U.S. The anti-vaccine activists and the vaccine-causes-autism activists are ready to roll with every flu vaccine Teachable Moment that comes along. The more traction they can get by encouraging doubt and skepticism about flu vaccine among parents, the more children will end up unvaccinated against the “usual” childhood diseases. So in the U.S., this is a really bad time to change the flu vaccine any more than necessary (a strain change is necessary, of course). (Jody Lanard in the Comment Thread of yesterday’s post)
In essence (and read the whole comment here), Dr. Lanard is saying it will backfire and make things worse. Instead of more people being vaccinated because of antigen sparing, fewer in the US will be vaccinated because parents will refuse the vaccine and it will have a spillover effect on other important childhood vaccination programs.
I understand this point of view and it comes from what I consider an authoritative source. But here’s where the question of “balance” that I discussed in yesterday’s post comes in. Jody and I have struck different balances on this. For us, the principal point of using adjuvant is to increase the number of people in the world who can be vaccinated, not just the number of people in the United States. Most of the viral antigen is made outside the US. We are rich so we bought it up and now less rich countries can’t get it. Our only entitlement to it is through the fact that the ability to live without influenza infection has become a commodity and the US has the means of exchange (money) to buy it. Adjuvants would make it more available to more people.
I am opposed to mandatory vaccination, even though I believe vaccination is an important public health measure that will save millions of lives. But there isn’t enough vaccine for everyone in the world, so if people in the US don’t want it, then any unused stock (keeping a small reserve) should be released by a date certain (say January 15 for the sake of argument) and given to others. I believe this will doom many Americans to severe sickness and some to a fatal illness, but the compensation is that many others, children and adults, in poorer parts of the world will be saved. Their lives are worth no less than American lives. If someone in this country, for whatever reasons, doesn’t wish to receive the vaccine, someone who wants it and needs it will be waiting.
September 8th, 2009
In response to the spreading swine ful pandemic, some on the left (and right, I imagine) are spreading the usual vaccines are a dangerous conspiracy ideas. One factor pointed to is that may vaccines contain ingredients, that have not received optimal testing. Revere at Effect Measure demolishes this argument. He also explains why it is essential for global equity that Americans receive a vaccine with an adjuvant to increase immunity, as occurs in Europe. The spreading of anti-adjuvant rumors are endangering the lives of many in the developing world. Is that what leftists ought to be doing?
Swine flu vaccines, adjuvants, equity, safety
When it comes to US swine flu vaccine policy, I’m not calling the shots, but if I were I’d do it differently than the current plan, which calls for a vaccine containing only viral antigen and no immunity boosting adjuvant. I opt for a vaccine with an adjuvant, probably the one that has been used for years in Europe, MF59. If I were to make a decision like that, I could well be making a mistake, because no one really can know at this point what is going to happen or not happen. We can only go on the best data we have coupled with some principles of what’s right. On that basis and using my own fallible judgment I’d move as fast as I could to develop, distribute and deliver a swine flu vaccine that contained an immununity-boosting adjuvant.
Europe’s adjuvanted flu vaccines don’t appear to be any less safe than non-adjuvanted ones and are far more effective and efficient in the use of the scarce active ingredient, the viral antigen. It is availability of viral antigen that is limiting vaccine production. Unadjuvanted vaccines require much more viral antigen than those with adjuvants. We have written about adjuvants many time here (e.g., here), and recently Vincent Racaniello over at Virology Blog had a great post on the likely requirement for an adjuvant in any swine flu vaccine that could be given with only one dose. Obviously anything that will make more protection available to more people is a good thing, but like everything in public health, there is a balance to be struck and no sure way in knowing how to strike it.
One balance is between the potential added risk of a vaccine with an adjuvant versus one without it. The risks are on both sides. Any vaccine carries a risk but a call to slow down approval until the safety of the vaccine and/or adjuvant is assured misunderstands the problem and carries the risk of killing people who might have gotten the vaccine earlier or in a more effective form. Let’s briefly discuss the safety issue (we’ve done it before, so this isn’t new). The problem with any vaccine, adjuvanted or not, is that it will be given to hundreds of millions of people. Any clinical trial would involve at most a few thousand. If some very rare adverse event occurred in one in every 100,000 people from the vaccine, then there would be 500 such events if 50 million people were vaccinated (roughly the number vaccinated in 1976 against swine flu). No clinical trial could pick up an event that rare. It would be invisible.
The difference is that in 1976 the virus never infected anyone outside of the soldiers at Fort Dix (see our post here). But the current virus has gone pandemic. If it infects (conservatively) 30% of the population of the US and the vaccine is 70% effective, we would prevent 10.5 million people from being infected (that’s the 1/6 we reach with vaccine — 50 million out of 300 million — 15 million [30%] of whom will be infected, of which 70%, or 10.5 million will be protected). If this is like seasonal flu, where the estimated CFR is 0.1%, we have 500 rare adverse events (some, but not all of which might be fatal) versus an estimated 10,500 flu fatalities and many more severely ill in the ICU. If the CFR is anywhere higher than 0.1%, the imbalance gets much worse. If we vaccinate many more than 50 million things tip in favor of the vaccine even more. But of course we don’t know the attack rate, the vaccine efficacy, the CFR or the rate of rare adverse events (1 in 100,000 is actually pretty high). But almost any way I figure it, vaccination comes out ahead and there is no way to estimate the rate of a rare adverse event prior to using the vaccine. That’s true for every drug or over the counter consumer product. It’s why we need good post market surveillance. But saying we’re going to wait to find out isn’t an option. It’s not feasible and it means no vaccine if we require it.
Another balancing problem. The regulatory approval process for an adjuvanted vaccine will take somewhat longer. The delay will mean that people who might have gotten vaccinated with an unadjuvanted earlier approved vaccine will be saved. This may or may not be true (Canadian authorities deny it). But the more important question has to do with global supply. If the rich countries like the US won’t use adjuvanted vaccine, they will use up twice as much or more of the scarce viral antigen, meaning that much less for the rest of the world, including the world’s poorest countries. Helen Branswell has a typically thorough article on the debate:
Individuals and organizations concerned about global equity are urging countries with vaccine contracts to stretch supplies by using boosting compounds called adjuvants so developing countries can also get some serum.[snip]
The WHO had asked countries with first access to pandemic shots to employ vaccine sparing approaches, such as the use of adjuvants, so that there will be more to go around. Without frugal use in wealthy countries, the vast majority of nations will have limited access, at best, to vaccine against the novel H1N1 virus.
U.S. authorities have made it clear they will only use adjuvanted vaccine if their supplies won’t meet American needs. They will not use the boosting compounds to stretch supplies for the developing world.
That position has also drawn fire, including by the head of the Gates Foundation’s global health program.
In a commentary published in the New England Journal of Medicine, Dr. Tachi Yamada said it would be inexcusable for people in poorer countries to die because richer countries use up most of the limited vaccine supplies. And he specifically pointed to the reluctance to use adjuvanted vaccines, currently licensed in parts of Europe but not in North America.
“Under a global health crisis where millions could die we have to really think hard whether we play by the rules we establish for normal times, or we think much more aggressively and take greater risks,” he said in an interview last month. (Helen Branswell, Canadian Press)
There are a lot of other balance issues here, including one raised by WHO’s vaccine chief Dr. Marie-Paule Kieny. If the swine flu virus drifts genetically, those getting an adjuvanted vaccine may be at an advantage.
The bottom lines for me as a public health professional and as an advisor to friends and family is this. For reasons of global equity and plausible public health advantage, the US should move expeditiously to an adjuvanted vaccine, probably with something like the MF59 adjuvant that has been used for a dozen years in Europe without apparent mishap. I will myself get both seasonal flu vaccine, and when my turn in the queue comes, the swine flu vaccine (containing an adjuvant, I hope, which would be especially helpful to people my age). I will urge every member of my family from my youngest grandchildren to my aged mother-in-law to do the same, and to add pneumococcal vaccine to the mix if they haven’t already done so. I will urge this on anyone and everyone who asks or is within hearing to do the same. But . . .
I am not in favor of forcing people to be vaccinated. If too many people decline this could result in a public health tragedy, the loss of life or productivity that could have been saved. If enough people are vaccinated to produce sufficient herd immunity to dampen an epidemic, those who aren’t vaccinated will have been free-riders, but that’s the way it is sometimes. Some will decline out of fear, some will decline out of selfishness, some will decline out of ignorance, too many will be denied by lack of access. And some will, like me, make a decision based on their own informed and considered judgment and come up with a different answer.
Good luck to all of us.
September 7th, 2009